Safety of limited supplemental iodinated contrast administration in azotemic patients undergoing CO2 angiography.

ABSTRACT

PURPOSE: To determine if limited doses of iodinated contrast significantly worsen the underlying renal insufficiency that had warranted the use of CO(2) for diagnostic angiography. METHODS: The records of 122 consecutive patients who had undergone CO(2) angiography for peripheral vascular disease at our institution over a 5-year period were reviewed. The volume and type of iodinated contrast and the volume of CO(2) administered were recorded. Serum creatinine measurements obtained before angiography and from 2 to 3 days after angiography were recorded. RESULTS: One hundred patients had pre-angiography and post-angiography creatinine levels available for analysis (51 CO(2) only, 49 CO(2) with iodinated contrast). The average pretreatment creatinine level was 2.8+/-1.5 mg/dL (range 1.8-6.6) for the CO(2) only group and 3.0+/-1.4 mg/dL (range 1.8-8.2) for the CO(2) plus iodinated contrast group (p=0.46). After angiography, the mean change in creatinine was +0.17+/-0.87 mg/dL for the CO(2) only group and +0.03+/-0.98 mg/dL in the CO(2) plus contrast group (p=0.27). Complications included 1 patient with a failing renal transplant who received iodinated contrast and ultimately required return to hemodialysis. A second patient had a transient 1-mg/dL rise of creatinine but did not require dialysis. CONCLUSIONS: This study supports the relative safety of CO(2) angiography with the limited used of iodinated contrast supplementation for diagnostic studies or interventions in azotemic patients with peripheral vascular disease.